HomeMy WebLinkAboutPermit Mechanical 1992-10-19. CITY OF OBEGO'V
SPFIilcFTELE'
Job Lbcation:
Assessors Hap *:Tax Lot *:
Ovner:
Address:*:
Ci ty State:Zipz
VaIue
(
/PeIIet Stove/fnsert:
appropri ate appliance
Preriminary rnspection is $15.00 (prior to instarration of insert)
Vood Stove/Pellet/Insert P is$15.00 +s 0.00 Issuance +state surcharge.
Type of Insp ion Request
Con t rac tor:
Address:Phone *:
Ci tyt State:zip:
Construction Contractors Registration *:Expires:
By signing this permit/application, I agree to call for an inspection(s) as required
(726-3769). I state that all information on this applieation/permit is correct and
that I vas provided vith the llood Stove Safety information for vood burning
UOOD STOVE/INSERT INSPECTION APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 Fifth Street
Springfield, 0regon 97477
0ffice:
INSPECTION LINE:
72
pection standards. I further state that the appliance
ssion standards as set by the Oregon Department of
eral Environmental Protection Agency and I agree to
number to the inspector at the time of inspection. I
requesting a preliminary inspection, the valI covering
Date
FOR OPFICE USE
PELLET/INSERT PRELIMINARY
Job *:
rl
app
Ia
Env
pro
a1s
liances and prelim
m installing
I ron 0
v1 t
d
L
ture
REQUIRED INSPECTION(S) :
Date of Application:
Total Amount CoIIected:
Receipt *:t
26-3769
Checked for Delinquencies:
Issued By:
ch for Historical Status:
)(
1
2
Fill in t
A
3.B
I hereby
the
gnature rm pplicant
CONSTRUCTION CONTRACTORS BOARD
0244J 8191
Owners about Construction Responsibilities on the
Permit No:
Address
lssued Date:
OR OFFICE USE ONLY
STATEMENT:
INFORMATION NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
Note: Oregon Law, ORS 701.055(4) , requires residential construction permit
applicants who are not registered with the Construction Contractors Board to
sign the following statement before the building permit can be issued. This state-
ment is required for residential building, electrical, mechanical, and plumbing
permits. Licensed Architect and Engineer applicants, exempt from registration
under ORS 701.010(7), need not submit this statement. This statement will be
filed with the permit.
plicable blanks, and initial boxes 1 and 2, and either box 3A or 38
I own, reside in, or will reside in the completed structure.
I understand that I must register as a construction contractor if the structure is sold
or offered for sale before or upon completion.
My general contractor is
Contractor registration number-.
I will instruct my general contractor that all subcontractors who work on the struc-
ture must be registered with the Construction Contractors Board.
I will be my own general contractor.
lf I hire subcontractors, I will hire only subcontractors registered with the Construc-
tion Contractors Board. lf I change my mind and do hire a general contractor, I will
contract with a contractor who is registered with the Construction Contractors Board
and I will immediately notify the office issuing this building permit of the name of
the contractor.
ation is correct and that ! have read and understand
3
at
Date
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
I
OR
a